Stages and Prevention of Brain Cancer

** Below is description of the various tumour grades, based on the World Health Organization (WHO) grading system.

• Grade I is a separate group of tumours called juvenile pilocytic astrocytoma (JPA). The term juvenile does not refer to the age of the patient, but the type of cell. This is a noncancerous, slow-growing tumour that can often be cured with surgery. It is different from a low-grade astrocytoma or Grade II glioma, which is likely to come back after treatment.
• A Grade II tumour does not have dead cells in the tumour, called necrosis, but shows an abnormally large number of cells, called hypercellular. A Grade III tumour is hypercellular and has cells that are actively dividing, called mitosis. It is often called anaplastic astrocytoma.
• A Grade IV tumour is usually a glioblastoma, also called glioblastoma multiforme or GBM. Cells in the tumour are actively dividing, and it has blood vessel growth and areas of dead cells in addition to the factors common to grade II and III tumours.

Age of patient – In adults, the age of the patient and his or her level of functioning, called functional status (see below) when diagnosed is one of the best ways to predict a patient’s prognosis. In general, a younger adult has a better prognosis.

Extent of tumour residual – Resection is surgery to remove a tumour, and residual refers to how much of the tumour remains in the body after surgery. Four classifications are used:

• Gross total: The entire tumour was removed. However, microscopic cells may remain.
• Subtotal: Large portions of the tumour were removed.
• Partial: Only part of the tumour was removed.
• Biopsy only: Only a small portion, used for a biopsy, was removed.

A patient’s prognosis is better when all of the tumour can be surgically removed.

Tumour location – A tumour can form in any part of the brain. Some tumour locations cause more damage than others, and some tumours are harder to treat because of their location.

Functional neurologic status -The doctor will test how well a patient is able to function and carry out everyday activities by using a functional assessment scale, such as the Karnofsky Performance Scale (KPS), outlined below. A higher score indicates a better functional status. Typically, someone who is better able to walk and care for themselves has a better prognosis.

• 100 Normal, no complaints, no evidence of disease
• 90 Able to carry on normal activity; minor symptoms of disease
• 80 Normal activities with effort; some symptoms of disease
• 70 Cares for self; unable to carry on normal activity or active work
• 60 Requires occasional assistance but is able to care for needs
• 50 Requires considerable assistance and frequent medical care
• 40 Disabled: requires special care and assistance
• 30 Severely disabled; hospitalization is indicated, but death not imminent
• 20 Very sick, hospitalization necessary; active treatment necessary
• 10 Moribund, fatal processes progressing rapidly
• 0 Dead

Metastatic spread – A tumour that starts in the brain or spinal cord, if cancerous, rarely spreads to other parts of the body in adults, but may grow within the CNS. For that reason, with few exceptions, tests looking at the other organs of the body are typically not needed. A tumor that does spread to other parts of the brain or spinal cord is linked with a poorer prognosis.

Biogenetic markers – Certain molecular markers found in the tumour tissue can provide information on whether treatment will work well. For instance, for oligodendroglioma, the loss of part of chromosome 1 on the p part of the chromosome, and the loss of part of chromosome 19 on the q part of the chromosome, called a 1p and 19q co-deletion is linked to more successful treatment, particularly with chemotherapy, and can be used to help plan treatment, especially for anaplastic oligodendroglioma.

Mutations in the isocitrate dehydrogenase (IDH) gene which is found in about 70% to 80% of low-grade gliomas in adults has been linked with a better prognosis. Higher-grade tumours can also have IDH gene mutations, which suggest that these tumours started as lower-grade tumours that became a higher grade. This mutation is also linked with a better prognosis in higher-grade tumours.

Prevention of Brain Cancer

Tumour Board Evaluation

Each and every Brain Cancer patient is evaluated by a special team of Neurologists, Neuro-oncologist, surgical oncologists (Head & Neck unit), Medical oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology and stage of the disease, a custom made treatment plan is charted out for each and every patient as per International Treatment Guidelines.

Because new treatments continually develop, several options may be available at different points during treatment. The pros and cons of each option are discussed during treatment planning

A team approach

1. Neurology – Patient’s initial visit will likely be with a neurologist who has expertise and additional training in neuro-oncology. This doctor generally serves as the “quarterback” for your care, coordinating tests and specialist appointments, and developing a plan of care.
2. Neurosurgery – neurosurgeons, performing hundreds of brain surgeries each year, using the latest technological advances, such as intra operative MRI, awake brain surgery and lasers.
3. Radiation oncology -Radiation oncologists use Intensity Modulated Radiation Therapy (IMRT) to kill cancer cells. Now, IMRT is being delivered through VMAT techniques in a continuous arc around patient effectively, from infinite delivery angles; reducing the integral dose to one tenth and treatment time to few minutes. IMRT is used for tumours arising from Head and Neck, Brain, Lungs, Lymphomas and Gynaecological Cancers.
4. Medical oncology -Medical neuro-oncologists manage chemotherapy or biological therapy, as well as medical disorders arising from the tumour or treatments. The neuro-oncology team of doctors, nurses and social workers use a careful and compassionate approach.
5. Neuropathology – Identifying your type of cancer is crucial to providing appropriate treatment.
6. Neuroradiology -Neuroradiologists specialize in the imaging of brain tumours. Doctors performs thousands of diagnostic tests on the head, neck and spine each year. These images are essential in guiding neurosurgery or radiation treatments, or deciding about other treatment options.

Other services – We offers access to other services, including supportive care, counselling, neurocognitive and neuropsychiatricservices,brain rehabilitation and pain management whenever needed.